On the Mental Health Needs Under the Russian Invasion in Ternopil, Ukraine: A Preliminary Report on the Provision of Mental Health Service

TO CITE THIS ARTICLE: Hino M, Kunii Y, Gerashchenko BI, Hamaie Y, Egawa S, Kuriyama S, Shevchuk OO, Korda MM, Venher OP, Tomita H. On the Mental Health Needs Under the Russian Invasion in Ternopil, Ukraine: A Preliminary Report on the Provision of Mental Health Service. Annals of Global Health. 2023; 89(1): 41, 1–6. DOI: https://doi. org/10.5334/aogh.4076 On the Mental Health Needs Under the Russian Invasion in Ternopil, Ukraine: A Preliminary Report on the Provision of Mental Health Service

Civilian casualties continue to multiply. Over 15 million civilians have been displaced across Ukraine or abroad. Thus, the conflict threatens to become the worst humanitarian crisis since World War II. Military attacks on houses and civilian installations are still ongoing in Ukraine. Transport routes have been disrupted, threatening the lives and livelihoods of many civilians. The humanitarian and psychological crises in areas close to and far from the combat zone had worsened during the winter of 2023, with repeated bombings of civilian infrastructure. Russian attacks had led to power and water shortages in many parts of Ukraine, resulting in frequent blackouts and posing a significant risk to nuclear power plant operations. Moreover, there are concerns about the use of chemical weapons and the possibility of intentional or accidental nuclear and radiological damage.
Thus, the current situation in Ukraine faces a serious, complex, and continuing CBRNE (chemical, biological, radiological, nuclear, and high-yield explosives) disaster [1]. The mental health consequences of CBRNE disaster are more complex and severe than those experienced in natural disasters. Comprehensive assessment beforehand is even more crucial for mental health care to individuals affected by CBRNE disasters; however, under the ongoing CBRNE disasters, assessment methods are often limited. Although information on the present situation in Ukraine is limited, there are concerns about the worsening of mental health status [2,3]. Hence, this report was formulated from a communication between former colleagues in Ukraine and Japan, on the assessment of the actual situation of the mental health services provision in Ukraine under the threat of CBRNE hazard posed by the 2022 Russian invasion.
The assessment items to summarize current mental health needs in Ukraine were created (Table 1), referring to the "Mental Health and Psychosocial Support in Emergency Setting (MHPSS)" [4] of the Inter-Agency Standing Committee (IASC). Also, items to summarize mainly current mental health service resources including some changes before and after the invasion were created (Table 2), referring to the World Health Organization Assessment Instrument for Mental Health Systems (WHO-AIMS) version.2.2 [5]. The mental health workers (co-authors) at Ternopil National Medical University (TNMU) accumulated information relevant to the assessment items. The ethics committee of the International Research Institute of Disaster Science, Tohoku University, approved this report.
Ternopil (estimated population: 225,004 in 2022) is a city located in the center of the Ternopil region (oblast) in western Ukraine, hosting many internally displaced persons (IDPs) from the eastern, northern, and southern combat zones of the country. Accordingly, the Volunteer Centre was established at TNMU, with students and staff involved in volunteer activities (https://vc.tdmu.edu.ua/).

TYPE OF INFORMATION INCLUDING ANSWER
Experience of the emergency     They also have been sending medicines and medical supplies to civilian and military hospitals, the Armed Forces of Ukraine, and territorial defense forces, to help IDPs in Ternopil (https://www. staffnet.manchester.ac.uk/news/display/?id=28436). Clinicians at TNMU have been volunteering at the free online health service, "Digital Clinic for Ukraine." In addition, psychiatrists at TNMU provided mental health support to civilians, IDPs, and soldiers, by giving up holidays to treat them at local hospitals or offering psychological support to them via phone calls (https://www.tdmu. edu.ua/2022/02/28/fahivtsi-tnmu-nadayut-psyhologichnu-pidtrymku-naselennyu/).
In Tables 1 and 2, this report presents the details of TNMU's responses to our assessment items. These responses, providing us with a vivid picture of the region's mental health care system in this challenging situation, can be summarized as follows. As expected, mental health problems, such as post-traumatic stress reaction, anxiety, panic reaction, psychogenic agitation, sleep disorder, stupor, and acute psychotic conditions, were growing in this region. Although the Ternopil region is located far away from the front line, psychiatric beds had been reduced from 770 beds to 630 due to the functional reorganization of medical facilities to accommodate injured and sick patients. Consequently, the number of psychiatrists in the Ternopil region decreased from 83 before the invasion to 70. Meanwhile, several voluntary psychological centers were established around the TNMU, and the psychiatry department continues to provide inpatient and outpatient care, launching telemedicine services. Thus, the sustainability of local psychiatric care was maintained through compensatory activities such as volunteer center organizations and telemedicine.
While it is difficult to grasp the situation in a country under armed invasions or war, such as Ukraine in 2022, from the outside, it may be worthwhile to share information on the current mental health care needs and resources for the provision of care internationally. It may attract positive interest in the current situation and promote consideration of possible countermeasures. We believe that the use of globally recognized and unified tools such as IASC-MHPSS and WHO-AIMS in other regions of Ukraine as well as in Ternopil will be useful in acquiring precise information about the mental health needs for the entire country and developing future support under international coordination.